Sexual Health

What Causes Perineum Pain?

The perineum is a part of the body present in both men and women1. The specific location is similar in both sexes.

In men, the perineum is located just behind the man’s scrotum. It extends toward the man’s anus.

In women, it starts at the front region where the vulva is found. The perineum also extends to the woman’s anus, similar to how it does in men.

Perineum pain occurs in some people. Other symptoms may accompany this. Some people may experience chronic pelvic pain in addition to symptoms at their perineum. Several potential causes may be behind such symptoms.

In this post, we consider what perineum pain is. We also focus on what the most common causes of pain in this area seem to be. This ranges from issues with pelvic floor muscles to conditions that may affect the perineum. The post also considers a few effective ways of reducing pain symptoms in the area.

What Is Perineum Pain?

Perineum pain refers to painful symptoms that occur in the perineal area. This area is often called the perineal body. In some cases, it is referred to as the central tendon of the perineum too. The tendon itself is located at the center of the patient’s perineum.

It is made from fibro-muscular tissue. In men, a deep, transverse perineal muscle is also found in the region.

The pelvic floor separates the perineum from the pelvic cavity2. The particular area is responsible for providing support to the gastrointestinal system.

The area also helps the urogenital system function normally. The perineum has a role in various functions of the body. This includes defecation, micturition, and sexual intercourse. In women, the perineum is considered a contributing factor in childbirth too.

Perineum pain is most common in women following childbirth. This is due to the trauma placed on the perineal area during this process. Up to 42% of women experience perineal pain after childbirth. The symptoms may remain present for up to 10 days3.

Even though common in women, men can experience perineum pain too. There are many reasons why men may experience such symptoms. Sometimes, the cause is not to be concerned about it. There are cases where an appointment with a doctor would be advised. This is because some causes may be more serious.

What Are The Symptoms Of Perineum Pain?

Several structures are closely located in the perineal area in the male body. This can make it hard to specify where pain symptoms are experienced.

Thus, in the case of perineum pain, the symptoms may feel like it is coming from other parts of the pelvic area too.

Men with a condition affecting the perineum can experience pain in various areas of their pelvis. Genital pain is generally considered a common symptom. Other symptoms include:

  • Suprapubic pain

  • Pain symptoms in the area where the bladder is located

  • Rectal pain

  • Sometimes, the anus may become painful too

  • Groin pain

  • Tailbone pain

In some men, back pain may also develop. There may also be a general discomfort when sitting down. Some men explain that it feels as if they are sitting on top of a golf ball. Pain may also be present after the man had a bowel movement4.

Urinary symptoms are also not uncommon in men with perineum pain. There may be an urge to urinate frequently.

Urinary hesitancy may also occur sometimes.

Nighttime urination may also increase. In some cases, there may also be a burning sensation when the man urinates.

Sexual pain can occur in some men with perineum pain. The pain may become worse when the man ejaculates. It is also possible for the pain to develop after the man has ejaculated. Some men will only experience the pain a day after they ejaculated.

What Causes Perineum Pain?

There are many reasons why perineum pain can occur. It is essential that men understand all of these causes. Any accompanying symptoms that may signal a specific cause should be taken note of too.

In women, perineum pain is mostly caused by a tear that develops during childbirth. In some cases, an episiotomy is needed when a woman is giving vaginal childbirth. In this case, a small cut is made in the perineum. This allows the vaginal opening to expand. This procedure will also cause painful symptoms.

In men, there are several possible reasons to be concerned. Sometimes, however, the cause may only be temporary and not harmful.

We take a look at some causes that have been associated with perineum pain below.

Perineum Trauma

Trauma is one of the first causes that we want to note here. This can lead to a perineal injury. There are several potential causes for trauma to develop with the perineum.

Consider a situation where a patient falls. When they fall, it is possible that they can hurt the perineum. When this happens, the perineum may become bruised and painful. An assault that affected the perineum in any way could also cause pain to develop in the area.

In these cases, muscles in the perineal area may be damaged. The skin in the area could be injured too. Scar tissue can also develop. These factors will cause pain in the region. The pain will generally be temporary. A man should be able to experience a reduction in symptoms after a few days.

Diabetes

In the United States, an estimated 8.6% of the population has type 2 diabetes. An additional 0.55% of the population has been diagnosed with type 1 diabetes5. These conditions are serious, long-term diseases that affect many functions and parts of the body.

Diabetes is known to cause nerve damage. Nerves throughout the body can be affected by the disease. This includes nerves that are located in the perineal region of the patient’s body. In such a case, neuropathic pain can affect a person. This includes neuropathic pain, the perineum.

While considering the nerve-related causes, it is also important to note that nerve entrapment may cause a pain syndrome to develop in the perineum too. In such cases, the patient can experience pelvic and perineal pain at the same time.

Pelvic Floor Dysfunction

The pelvic floor is an integral part of the pelvis. This is a group of muscles that sits at the bottom of the pelvis. The muscles support several organs that are located in the pelvic region of the human body. The urinary bladder is just one of the organs that the pelvic floor muscles support.

These muscles can sometimes become dysfunctional. The condition is referred to as pelvic floor dysfunction. Different factors can contribute to pelvic floor dysfunction.

One example would be a tightening of the muscles in the pelvic floor area. This can lead to tension in the area. Pain symptoms are also common when the pelvic floor muscles become too tight. Perineal pressure may occur when the pelvic floor muscles are tight.

In turn, the perineum may also become painful in the process.
In other cases, the pelvic floor muscles can become weak. This leads to problems like urinary incontinence.

The muscles are unable to provide effective support for the urinary bladder. The weakening of these muscles can also lead to pain in the perineal region.

Prostatitis

Men should take note that prostatitis is another possible cause of perineal pain. This is a condition that refers to inflammation that affects the prostate gland. In some cases, the inflammation is caused by the presence of an infection.

It is also possible for nonbacterial prostatitis to develop. In this scenario, the inflammation affects the prostate without the presence of bacteria or any type of infection.

Up to 8.2% of men will be affected by prostatitis at some point6. About 8% of all visits to a urologist are related to prostatitis. Additionally, about 1% of primary care visits by male patients are related to prostatitis too. Thus, this is a relatively common condition among the male population.

The inflammation that occurs with prostatitis can affect the perineum. A lot of men with prostatitis will experience pain symptoms in regions other than the prostate too. This can include the perineal area.

Additional symptoms will be present in men with prostatitis. They may experience painful urination and have urinating difficulties that develop. Some men can experience blood in their urine.

Other symptoms associated with prostatitis include:

  • Fever

  • Chills

  • Urethral discharge

  • Painful ejaculation

  • Sexual dysfunction occurs in some men

  • Malaise

  • Body aches

  • Abdominal pain

  • Grown pain

  • Rectal pain

  • Lower back pain

Some symptoms associated with prostatitis are similar to those that men generally experience with perineum pain. Thus, prostatitis should be considered a possible cause when the man develops pain in the perineum.

Infection

When bacteria or other microbes enter the body, they can invade several parts and lead to the development of infection.

When the perineum is infected with bacteria, the patient is likely to experience pain symptoms. This is not a very common cause of perineum pain.

Still, it is a possibility that men need to take into consideration. Pain is not the only symptom that may occur when the patient has an infection that affects their perineum. The swelling will also develop in the perineal region.

Infection that causes perineal pain will not always be directly related to the perineum. Sometimes, an abscess can occur in the anus. In turn, this can cause the patient to experience perineal pain.

It is important to remember that the perineum is closely located to the anus. Interstitial cystitis can also lead to perineal pain, even though the cysts and infection affect an area that is not directly situated on the perineum.

When To See A Doctor?

Some of the causes of perineal pain are considered mild and harmless. These causes are not be concerned about. The pain symptoms will generally reduce in just a few days. There are also cases where a more severe cause is behind the pain symptoms.

For this reason, men are advised to acknowledge when it would be more appropriate to see a doctor. Early diagnosis and treatment of some conditions can provide more positive results. Some conditions can also progress and lead to a risk of complications if left untreated.

Generally, it is advised that a man consults a doctor whenever he experiences perineal pain. There are a lot of factors that can contribute to pain symptoms. It would be difficult for the patient to point out the cause on his own.

A physical examination and some questions from a doctor may help to provide a clearer overview of why the man is experiencing perineal pain.
It becomes especially crucial for a man to see a doctor if he experiences additional symptoms.

This may include urinary difficulties, blood in urine, or pain that radiates to other areas of the pelvic region. Additionally, men should also ensure they see a doctor if the pain continues to persist after several days.

How To Relieve Perineum Pain?

The treatment for perineum pain depends on why the man is experiencing the symptoms. Treatment for pelvic pain syndrome would be different than what would work for prostatitis as an example. This is why an appointment with a doctor is generally advised before treatment is initiated.

A doctor will be able to assist in determining the cause behind the pain that the man experience. The doctor will also be able to request additional tests if needed. This allows for a diagnosis to be made. Appropriate treatment can then be prescribed to the patient. This treatment will focus on addressing the root causes of the pain.

In some cases, there isn’t a specific treatment for a cause behind perineal pain. This was generally the case when the pain symptoms were caused by injury or trauma.

In these scenarios, pain medication and anti-inflammatory drugs may be used. These may help to provide temporary relief of the pain the man experience. The body will heal from the injury on its own. The anti-inflammatory drugs can help to keep swelling to a minimum while healing takes place.

In cases of conditions like chronic bacterial prostatitis, certain medications may be needed. Bacterial prostatitis is generally treated with antibiotics.

Conclusion

The perineum is located close to the anus. In some people, pain symptoms may affect this part of the body. There are many possible causes behind pain in the perineal area.

We considered some common causes that patients need to realize. Some people experience perineal trauma, which may lead to pain symptoms.

In other cases, conditions like chronic nonbacterial prostatitis may affect the region too. Understanding the causes makes pain relief easier and more effective.

Sources

  1. StatPearls [Internet]. (2018) Anatomy, Abdomen and Pelvis, Perineal Body. [online] Available at: https://www.ncbi.nlm.nih.gov/books/NBK537345/
  2. TeachMe Anatomy. The Perineum. [online] Available at: https://teachmeanatomy.info/pelvis/areas/perineum/
  3.  SpringerLink. (2019) Incidence of perineal pain and dyspareunia following spontaneous vaginal birth: a systematic review and meta-analysis. [online] Available at: https://link.springer.com/article/10.1007/s00192-019-03894-0
  4. Prostate Cancer, 911. (2017) What Is Perineal Pain (Perineum Pain)? [online] Available at: https://prostatecancer911.com/what-is-perineal-pain-perineum-pain/
  5. Morbidity and Mortality Weekly Report. (2018) Prevalence of Diagnosed Diabetes in Adults by Diabetes Type – the United States, 2016. [online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5877361/
  6.  American Family Physician. (2010) Prostatitis: Diagnosis and Treatment. [online] Available at: https://www.aafp.org/afp/2010/0815/p397.html

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